地中海饮食

一、定义与概述

“地中海饮食”是一个通用术语，用于描述地中海沿岸国家（包括希腊、意大利、法国南部、克里特岛、西班牙及中东部分地区）居民的饮食模式。本文将从广义角度探讨地中海饮食，涵盖其在全球化前的起源阶段至如今的应用。

在20世纪50年代大规模贸易出现之前，人们的饮食受地理环境限制，以当地可获取的食材为主，因此多数饮食具有季节性差异。地中海饮食以植物性食物为核心，动物性食物主要包括鱼类和禽肉，乳制品摄入量有限。尽管现代版地中海饮食中红肉和加工食品的比例有所上升，但其核心定位始终未变——以植物性食物为主，并搭配健康脂肪。

地中海饮食的食材选择主要包括：绿叶蔬菜、各类豆类、坚果（如核桃、杏仁、开心果）、新鲜水果及全谷物。由于地中海地区是橄榄油的主要产区，橄榄油也成为该饮食模式的核心食材。橄榄油属于单不饱和脂肪，含有α-亚油酸（一种必需Omega-3脂肪酸），研究表明该成分具有心血管保护作用^[1]。

研究认为，地中海饮食通过降低多种风险因素^[2][3][4]，成为其降低心血管疾病发病率的主要原因。鱼类及其他海产品能提供丰富的Omega脂肪酸，这也是该饮食模式具有心血管保护作用的另一重要原因^[5]。

此外，需提及的重要一点是“适度饮用葡萄酒（尤其红酒）”——有研究表明此举可能带来多种代谢益处，其中最稳定的益处体现在脂质代谢方面。研究认为，乙醇（酒精）是该益处的主要贡献者，但其微量成分也可能在止血和炎症调节中发挥重要作用^[6]。

二、关注问题

为获得最佳预防效果，需严格遵循地中海饮食，但在当今社会，这种严格依从性对多数人而言并不现实。因此，需明确一点：若仅间歇性遵循该饮食，或仅采纳其中部分内容，其健康益处会显著降低^[5]。

肠道微生物组对整体免疫功能、心血管功能、内分泌功能及消化系统功能（这一作用更为直观）均有重要影响，且研究发现肠道微生物组可能在短短4天内发生变化——这一结论进一步凸显了长期坚持地中海饮食的重要性^[7][8]。

同时需注意，地中海饮食的整体有效性还需结合体育锻炼；与所有饮食模式相同，“适度摄入”也是关键原则之一。此外，个体口味偏好差异（如偏爱咸味而非甜味）会导致饮食依从性存在较大个体差异^[9]。

尽管多数研究表明地中海饮食可改善心血管风险因素，但部分观点认为这些研究的证据质量仅为“低到中等”^[10]。另有部分研究显示，该饮食模式对炎症标志物或代谢风险因素的检测值无改善作用^[11]。

值得注意的是，已发表的研究多以成年人为研究对象，针对其他年龄段人群的研究仍需补充。但或许最显著的依从性障碍是：不同研究对“地中海饮食具体包含哪些内容”的推荐标准并不统一。

三、临床意义

观察性研究和随机对照试验均证实了地中海饮食的预防益处。支持该饮食模式的里程碑式研究是“七国研究”（Seven Countries Study），该研究表明，坚持地中海饮食的人群，其心血管疾病总体风险显著降低、发病率显著下降，此后多项研究也得出了类似结论^[12][13]。

另有多项研究显示，特定亚组人群（如非酒精性脂肪肝患者、家族性杂合子高胆固醇血症（HFH）患者、近期发生心肌梗死的患者）坚持地中海饮食后，疾病风险也会降低^[14][15][16]。这些发现表明，地中海饮食的益处可能具有更广泛的适用性。

研究已证实，地中海饮食可改善“具有高心血管疾病风险的糖尿病患者”的血糖控制水平，降低其胰岛素抵抗^[17]；另有多项研究显示该饮食模式可延缓早期血管老化^[18]。基于上述保护作用，地中海饮食的益处可能同样适用于代谢综合征患者^[19]。

此外，有研究提示地中海饮食可能降低其他健康问题的发生风险，包括：骨质疏松、炎症性肠病、早产、黄斑变性、肾结石、干眼症、癌症（乳腺癌和结直肠癌）、神经认知障碍，以及特定抑郁症患者的病情进展^{[20][21][22][23][24][25][26][27][28][29][30][31]}。

四、护理、相关健康领域及跨专业团队干预

采用跨专业团队协作模式提供整合性患者护理（尤其在风险因素干预方面），可实现最佳整体预后。初级保健医生会每日向患者强调风险因素干预的重要性，而将患者转诊至注册营养师通常会带来额外益处。此外，还应建议患者进行常规有氧运动。

目前，“饮食改变咨询需纳入地中海饮食相关讨论”已成为广泛共识，但仍需更多研究进一步验证^[32][33]【证据级别：1级】。

由于严格的地中海饮食缺乏统一的具体标准，其推荐难度较大。Davis等人曾针对地中海饮食开展大规模文献综述，试图明确各类食物及特定营养素的推荐摄入量，最终得出以下结果：

上述推荐量对应的每日热量约为2200千卡（9300千焦），其中总脂肪供能占比37%（单不饱和脂肪18%、饱和脂肪9%），膳食纤维摄入量为33克^[34]【证据级别：1级】。

五、护理、相关健康领域及跨专业团队监测

目前已存在地中海饮食依从性评分系统，该系统基于“特定疾病发病率和死亡率模型”，可帮助患者认识到坚持饮食的重要性^[35]。

临床实践中，需持续常规鼓励患者进行风险因素干预，并为其提供必要资源，以支持生活方式的改变，从而改善整体健康状况。此外，可开展常规血液监测，包括血脂、糖化血红蛋白（HbA1c）及肾功能检测。

六、参考文献

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